Provider Demographics
NPI:1871521138
Name:TAYLOR, SCOTT DONALD (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DONALD
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 VICKERS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-4649
Mailing Address - Country:US
Mailing Address - Phone:812-379-9524
Mailing Address - Fax:812-376-6383
Practice Address - Street 1:4225 VICKERS DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-4649
Practice Address - Country:US
Practice Address - Phone:812-379-9524
Practice Address - Fax:812-376-6383
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044951208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200089250Medicaid